Laserfiche WebLink
Jun 06 2017 12:25PM Washington Water 10 <br /> rs 8663757454 page 1 . <br /> PERMIT APPLICATION <br /> 4err BUILDING /MECHANICAL/PLUMBING 1 SIGN /SPRINKLER/ DEMOLITION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET,EVERETT,WA 98201 <br /> (P)425-257-8810 I FAX 425-257-8857 1(E)everetteps@everettwa.gov everettwa.gov I www.everettwa.gov/permits <br /> Blue or Black Ink Only Please) PROJECT SITE INFORMATION <br /> PROJECT SITE ADDRESS: I 12- 1-116 PROPERTY TAX MOOgNO3LI&Q31(J <br /> LEGAL fur new construction: Short Plat/subdivision Lot No.____ (attach copy of long legal description) <br /> RM <br /> �� CONTACT INFORMATION <br /> OWNER NAME; r r TENA T NAME(If Commercial); <br /> OWNER MAILING ADDRESS: STREET 5(Z <br /> CITY STATE � 7�p <br /> OWNER PHONE; q OWNER EMAIL: <br /> CONTRACTOR NAME: uJfEShf c�Gr�GN fT�s <br /> CONTRACTOR ADDRESS: STREET /-715 Z <br /> CITY tAJ-arl uf�- <br /> STATE zip <br /> CONTRACTOR PHONE: T Z J —�g3— r 1— b` CONTRACTOR EMAIL: (l C M Ilii (om <br /> r nNTRor.Tna I Irr=htSE JntRCQulncoi �,lJj�SlixY �f do 'I I r ur tvtKtl r dUSINkSS LICENSE#(REQUIRED): U f2j r <br /> PRIMARY CONTACT: ❑OWNER CONTRACTOR ❑OTHER(Please Specify) <br /> CONTACT NAME- ! C <br /> ONTACT PHONE: 2.�j� 3_[fg7/ <br /> ONTACT EMAIL; I,{�{��,(J�C}f f� I I�/r L / <br /> B LDING PERMIT APPLICATION <br /> Existing Use of Buildin --lContract Price of Work:$ <br /> Proposed Use of Building: Heat Source: ❑Gas ❑Electric ❑Other <br /> Buildin T pe ❑SFR-Detached ❑SFR-Attached ❑Duplex ❑Multi-Family-#of Units: ❑Commercial 01nduslria' <br /> Type of Project: El New ❑Addition ❑Remodel ❑Repair ❑T.I. ❑Sign ❑Sprinkler ❑Demolition ❑Change of Us <br /> DESCRIPTION OF WORK: <br /> 1 ASSOCIATED BUILDING PERMIT#(if applicable): <br /> MECHANICAL PERMIT APPLICATION PLUMBING PERMIT APPLICATION <br /> Type of Project: _New _ Addn Alteration _Repair Type of Project: _New _Addn Alteration Repair <br /> ft of #of #of #of <br /> Fixtures List of Fixtures Fixtures List of Fixtures FixturesList of Fixtures Fixtures List of R'xtures <br /> A/C—Air Handling Units Heat Pump Toilet Backflow Preventer(inside B'dg) <br /> Forced Air Systems Unit Heater Bathtub Urinal <br /> Gas Pi inc Bciier Lavatory(Wash Basin) Drinking Fountain <br /> Water Heater Refrigeration Shower Floor Drain <br /> Gas Fireplace lWood Stove Kitchen Sink.& Disposal Grease Trap <br /> Gas Range Ducting Dishwasher Roof Drains <br /> Clothes Dryer Hookups Other: Clothes Washer Medical Gas <br /> Range Hood Water Heater Other: <br /> Exhaust Fan Sink(Service/8ar/Ma /etc.) Other: <br /> SPRINKLER I SUPPRESSION SYSTEM <br /> Number of Heads <br /> ACKNOWLEDGEMENT:t have reviewed this epplicatron and confirm the information conta,ned herein is true and correct.Work done pursuant to this permit must compry with <br /> current federal,sidle,and local law The orantino of rprm#nn/Jr atrthmires approved work and no doWotk no thornfro Doolotiona awaf 6W be au0"'ko r in mitlnu horn rhe <br /> Dui`dina oZtnr 601st t„�r„y u("#wfxeu urro'er iwy iownsrance.i am the owner,or 1 am authorized by the owner of this property to perform the work for which apprcatan is made, <br /> and f comply with the State Con6actors Law 18.27 Wand 296 200A WAG <br /> City of Everett Offlclat Use Only <br /> r �(,j✓ 6-647 PERMIT# <br /> MID Authorized Argent SignatureUa[e (Revd-sed 5/2012016) <br />